In recent years, endoscopic surgical operations have been extensively performed as a low-invasion surgical operation method. The endoscopic surgical operation is a low-invasion operation, and has advantages that the term of hospitalization is short and that a wound is small. On the part of the operator, there are disadvantages that since the operator performs the operation, using treatment instruments, such as a plurality of forceps, while viewing an image projected on a screen by the endoscope, the manipulation is difficult, and much time is required, so that the operator undergoes a considerable stress. Particularly, it tends to take a long time to perform an operation on the stomach and the large intestine, and the operator undergoes a great stress. Therefore, when it is expected that a large sample is finally taken out after a treatment under an endoscope is effected, there is required a surgical treatment instrument capable of easily closing a small incision (on the premise that such a smaller incision is formed) so that the procedure can easily shifted from the treatment under the pneumoperitoneum condition to the treatment applied to the internal organ taken out to the body surface through the small incision.
JP-A-11-160942 discloses a device which comprises members for gripping the abdominal wall to fix the same, and a cylindrical member, and the spacing between the abdominal wall-gripping members is adjusted by a simple mechanism in which threads or the like, beforehand fixed to the fixing member inserted in a peritoneal cavity, are pulled up, and are fastened to the fixing member disposed outside the peritoneal cavity. In this surgical treatment instrument, when a pneumoperitoneum condition is again created, forceps can be inserted through a small incision, and can be operated thanks to the provision of two kinds of airtight members for maintaining an airtight condition when the treatment instruments is not inserted and when the treatment instrument is inserted.
By using this device, there can be performed an operation in which after a treatment, such as the abruption of those parts around the internal organ to be taken out, is sufficiently effected under a pneumoperitoneum condition, a small incision, having a size of about 3 cm to about 5 cm, is formed in that part through which the organ is to be taken out, and the organ to be treated is taken out of the body through this small incision, and the excision, extirpation and suture of the affected part are effected while the operator directly views this affected part. However, there have been encountered problems “that when the incision is opened by the threads, the threads are brought into biting engagement with that portion of the abdominal wall defining the incision, so that it is sometimes difficult to sufficiently open the incision”, and “that there are provided projections for fixing a fixing member spacing-adjusting sheet, and this sheet is provided around the opened incision, so that it is sometimes difficult to take out the organ and to effect the treatment.”
JP-A-10-108868 discloses a valve (capable of preventing the leakage of a pneumoperitoneum gas from the peritoneal cavity regardless of the kind of forceps to be used) and a trocar tube with the valve. This valve has a soft cylindrical member provided between two rings, and by twisting the two rings in opposite directions, respectively, forceps of different outer diameters and the arm of the operator can be inserted into the valve so as to effect a treatment within the body. By opening this valve, the internal organ can be taken out of the body, and can be treated. However, this method has a drawback that it is rather difficult to move the forceps or the like forward and backward since they are fixed by the valve in a squeezed manner. And besides, when the arm is inserted, it is sometimes difficult to maintain an airtight condition since the arm varies in thickness particularly in accordance with the forward and backward movement, and in this case it is necessary to adjust the throttling of the valve. Furthermore, the force of fixing of the device on the abdominal wall depends only on rubber elasticity of the cylindrical member, and therefore this device has a problem that it can not flexibly meet the thickness of the abdominal wall, so that the incision can not be sufficiently opened.
U.S. Pat. No. 5,480,410 discloses a device in the form of a soft enclosure having an inner surface and an open end. Spreading means for fixing the device to the abdominal wall and for maintaining an airtight condition is provided at the open end, and at least one access opening for allowing access to the interior of the enclosure is provided, and a surgical operation can be effected in the peritoneal cavity or within the enclosure. This device is not a rigid trocar as heretofore used in a laparoscopic operation and a thoracoscopic operation, but this device is made of a soft sheet material, and the spreading means, which can be deformed into a shape corresponding to the shape of an incision in the abdominal wall, is inserted through the incision, and is spread in the peritoneal cavity, and carbon dioxide gas for pneumoperitoneum purposes flows from the peritoneal cavity into the enclosure to expand this enclosure, and the spreading means maintains an airtight seal between the device and the abdominal wall. In the case where a plurality of access openings are provided in the outer peripheral surface of the enclosure, a plurality of forceps can be inserted into the enclosure, and that part beneath the incision can be observed, and the edge of the incision is protected. However, the enclosure basically has a spherical shape, and the distances to the respective access openings, provided in the outer peripheral surface, are determined and fixed when the device is set. Therefore, when one of the plurality of treatment instruments, inserted in the enclosure, is much moved, the other treatment instruments are also moved, following this treatment instrument. In addition, the incision in the abdominal wall is large relative to the treatment instrument such as forceps, and any portion of the abdominal wall does not serve as a fulcrum for the treatment instrument during the manipulation thereof, so that the manipulation of the forceps is complicated. And besides, the opening of the incision depends only on the stretchability of the sheet, and therefore there has been encountered a problem that the thickness of the abdominal wall may prevent the incision from being sufficiently opened.
U.S. Pat. No. 5,640,977 discloses a device in which this structure includes an outer sleeve, and two seal means, and this device is inserted into the peritoneal cavity through a small incision, and an airtight space is formed within the outer sleeve by the use of the two seal means. In this device, when the hand and arm of the operator is inserted into the body through the interior of this device, the internal organ can be treated in a pneumoperitoneum condition. And besides, even when the arm is withdrawn, the airtight condition in the body can be maintained if third seal means is used. However, this device has such a structure that even when the operator wants to take the internal organ out of the body so as to treat it, the sleeve portion is adhesively bonded to a drape covering the body surface of the patient. That portion, extending outwardly from the bonded portion, can not be separated, and therefore unless the drape is cut so as to once take out the whole of the device or unless the sleeve portion is cut, the organ can not be taken out of the body, and can not be treated. If the device is taken out, there is a fear that a cancer-affected tissue adheres to the abdominal wall. If the sleeve portion is cut, a pneumoperitoneum condition can not be again created after the treatment outside the body is finished, so that the observation and treatment in the peritoneal cavity can not be effected.
U.S. Pat. No. 5,813,409 discloses a device (and others) in which a sleeve is separate from an abdominal wall-fixing portion, and a ring, provided at a remote end of the sleeve, is snappingly fitted relative to a ring of the abdominal wall-fixing portion, thereby fixing the device. In this device, the sleeve can be separated from the abdominal wall-fixing portion, and therefore the sleeve portion is removed, with the abdominal wall-fixing portion remaining on the abdominal wall, and in this condition the internal organ can be taken out of the body, and can be treated. Therefore, a cancer-affected tissue will not adhere to an incision, and after the treatment is finished, the organ is returned into the body, and the sleeve is again fixed, and the observation and treatment can be effected under a pneumoperitoneum condition. However, it is difficult to snappingly fit the rings of the sleeve and abdominal wall-fixing member together over their entire periphery, and if this fitting connection is incomplete at any region, an airtight condition can not be maintained. Also in this device, when a treatment instrument such as forceps is manipulated through the sleeve, there has been encountered a drawback that the manipulation of the forceps is complicated since an incision in the abdominal wall is large relative to the treatment instrument, and any portion of the abdominal wall does not serve as a fulcrum for the treatment instrument during the manipulation thereof.
U.S. Pat. No. 5,366,478 and JP-A-2000-501978 disclose devices in which by inflating a continuous doughnut-type balloon over a region outside and inside the body, an internal cavity is closed, and an airtight condition is maintained within the peritoneal cavity when inserting and withdrawing the hand or forceps. This device is simple in structure, and can be easily assembled, and therefore the time, required for an operation, can be reduced. However, in the device of U.S. Pat. No. 5,366,478, when the organ is to be taken out of the body for treatment purposes after a pneumoperitoneum condition is canceled, the balloon must be contracted with the result that an incision is closed, and therefore there has been a drawback that an additional incision-opening instrument must be used. In both of the above devices, the balloon is inflated in the circumferential direction, so that the height of the device from the body surface increases, and therefore it is difficult to sufficiently take the organ out of the body, and besides there has been encountered a problem that forceps or the like can not be easily located at that part to be treated.
JP-A-11-99156 discloses a device in which a sleeve is fixed to the abdominal wall by ring-like members disposed respectively at the upper and lower sides of the abdominal wall, and there are provided two valves (one of which is an ordinary seal valve while the other valve is formed of an elastic thin membrane, and has a slit-like opening, and with this construction the air-tightness is enhanced when the hand is inserted and not inserted. In this device, when the hand and forceps are not inserted, the slit-like valve is expanded by a peritoneal pressure in such a manner that contact surfaces, formed by a folded portion, are pressed against each other, thereby maintaining the airtight condition. Therefore, when the valve is opened upon insertion of the hand, a force other than the resilient force of the elastic thin membrane will not be produced, and therefore the force, squeezing the arm, is very small, and in long-time use, a stress on the operator is reduced. However, this device has a drawback that when the organ is to be taken out of the body for treatment purposes after a pneumoperitoneum condition is canceled or when an affected part is to be treated while directly viewing this part through an incision, particularly the slit-like valve becomes obstructive. Also in this device, when a treatment instrument is manipulated through the sleeve, there has been encountered a drawback that the manipulation of the treatment instrument such as forcepts is complicated since an incision in the abdominal wall is large relative to the treatment instrument, and any portion of the abdominal wall does not serve as a fulcrum for the treatment instrument during the manipulation thereof.
U.S. Pat. No. 5,741,298 discloses a device in which there is provided a port which firmly grips that portion of the abdominal wall, disposed around an incision, at its outer and inner sides, and is fixed thereto, and an internal cavity is closed by a lid attached to this port so that the peritoneal cavity is kept airtight when forceps are inserted and withdrawn. This device is simple in structure, and can be easily assembled, and therefore the time, required for an operation, can be reduced. However, this device can not flexibly meet the size of the incision and the thickness of the abdominal wall, and therefore there has been encountered a problem that the incision can not be sufficiently opened.
U.S. Pat. No. 5,653,705 discloses a device in which an annular member of a tapering shape, having threads, is threaded into the abdominal wall, and is fixed thereto, and a flexible envelope of the detachable type is attached thereto, and the interior of the peritoneal cavity is kept airtight when the hand or forces are inserted and withdrawn. In this device, an access port can be easily provided merely by threading the annular member into an incision, and the annular member can serve as a fulcrum for the forceps, so that the forceps can be easily manipulated. However, there has been a fear that the incision is damaged since the annular member is threaded into the incision. And besides, there has been encountered a problem that the annular member becomes bulky since the thread angle, facilitating a threading operation, is provided, and furthermore there has been a drawback that this device can not flexibly meet the thickness of the abdominal wall and the size of the incision.